Hybrid Clinic Registration

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Spring 2021 Clinic Registration Form

Name*
First Last
Name for badge
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Daytime Phone*
Cell Phone
Sharing your cell phone number with us is important as it may help us communicate with you during a Clinic
Clinic Information
Clinic Location - Date*
Select the clinic you will attend. Fly local means to schedule a half-day flight with a BPT Instructor at a later date at your location. You are responsible for the Instructor’s travel expenses. If the clinic is less than a week from now, please call 970-206-0182 to register.
How many BPT (or similar) weekend clinics have you previously attended?
Please enter a number from 0 to 30.
Pilot Registration for Hybrid Clinic*
- Full Course: Virtual Ground School + Flying $1,195
- Virtual Ground School Only $500
Aircraft Information
Aircraft Type
Aircraft N#*
Year aircraft built
Dual Controls?*
- Yes - dual control yoke
- No - single control yoke
Turbocharged/Turbonormalized?
- Yes
Allison Turboprop?
- Yes
What GPS, Autopilot, MFD or other special equipment does your aircraft have?
Are you sharing an aircraft with another attendee? If so please provide his/her name
Please answer the following questions about your flight time
Estimated total time*
Bonanza time
Baron/Travel Air/Duchess time
Duke time
Are you instrument rated?*
- Yes
- No
Pilot Certificate Number*
Insurance & Documents we must receive from you before your flight
- Insurance Certificate naming BPT Inc. as an additional insured
- Sign, date and return the Hold Harmless document
The above should be sent to our insurance manager at: registrar@pbpt.org

On the day of your flight you will complete a PIC Statement
Cancellation Policy
Your fee is non-refundable. If you are unable to view the Online Ground School when scheduled, you may watch the recorded video at a later date. If you cannot fly at the assigned time, you will have one year to complete a flight.
Grand Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Hybrid Clinic Registration

Take a minute. Take our survey.

Spring 2021 Clinic Registration Form

Clinic Information

Aircraft Information

Please answer the following questions about your flight time

Insurance & Documents we must receive from you before your flight

Cancellation Policy